Most home care clients rely on informal care from a spouse or child
OTTAWA, Aug. 26 /CNW/ - One in six people providing informal care to
seniors experiences distress, according to a new study released today by
the Canadian Institute for Health Information
(CIHI), and those caring for seniors with moderate to severe cognitive
impairment, such as those with Alzheimer's or other dementia, are most
The first of two related studies released today, Supporting
Informal Caregivers—The Heart of Home Care looked at
more than 130,000 seniors (age 65 and older), including many with
complex health conditions, who received publicly funded long-term home
care in 2007-2008.
Virtually all (98%) of these home care clients also relied on an
informal caregiver—a spouse, adult child, friend or neighbour who
provided emotional support along with assistance in daily living
activities, from shopping, transportation and medication management to
bathing, dressing and feeding.
About 55% of seniors in the study—and three-quarters of those who were
married—received informal care from a spouse, while almost 75% of those
who were not married received care from an adult child.
"Many seniors want to stay in their own homes as they get older, and
having a family member or friend provide informal care helps make this
possible," says Nancy White, Manager of Home and Continuing Care
Development at CIHI. "The good news is that most informal caregivers do
appear to be coping well. While caring for a loved one can be
fulfilling, it can also be quite challenging. It is important to
identify caregivers who are at risk of burnout, which can result in the
senior being institutionalized."
Using a standardized assessment tool, home care staff flag clients with
a distressed caregiver if the caregiver is unable to continue providing
care or if the caregiver expresses feelings of anger, depression or
Severe impairment does not always result in seniors being
admitted to residential care
The second study released today, Caring for Seniors With
Alzheimer's Disease and Other Forms of Dementia, found that
in 2007-2008, one in five seniors (20%) receiving long-term home care
had a diagnosis of Alzheimer's disease or other dementia. Nearly one in
six (17%) of these clients with dementia were suffering from moderate to
severe impairment in cognition and daily functioning yet still managed
to remain at home.
The study also found that one in six (17%) seniors with dementia living
in residential care facilities (such as nursing or long-term care homes)
in 2008-2009 had relatively low levels of impairment or could still
perform basic functions quite well on their own. The odds of a senior
with low impairment being placed in residential care were seven times
more likely if the senior had a tendency to wander.
Marital status was also a factor in determining whether a senior with
low impairment was newly admitted to a care facility rather than at home
with home care. The odds of being institutionalized were nearly double
for those who were not married, meaning they were widowed, divorced or
single, compared to those who were married.
Spouses more likely to experience distress
Supporting Informal Caregivers—The Heart of Home Care
found, when controlling for other factors, about one-quarter (25%) of
people providing informal care to their spouse reported distress.
Spouses were twice as likely to experience distress as other family
members, such as adult children.
The study also showed the chances of a caregiver of a home care client
experiencing distress were two and a half times greater for seniors
receiving 21 or more hours of informal care weekly compared to those
receiving 10 hours or less per week.
"It isn't unusual for spouses to experience distress when providing
informal care to their partner. This can likely be attributed to the
24-hour nature of their role, a potential lack of understanding of the
changes in their spouse's behaviour that are a result of the disease
process and the fact that they may be seniors themselves," explains
Kimberly Peterson, Vice President of Client Services with the Champlain
Community Care Access Centre. "There are many strategies informal
caregivers can use to help cope with distress. This includes accepting
that there are events they cannot change, taking some time to do
activities they enjoy and ensuring they get enough rest and sleep."
Cognition, depression, difficult behaviours linked to caregiver
After adjusting for other factors, the study found cognition problems in
home care clients related to memory, understanding and decision-making
were most strongly associated with caregiver distress. The odds of a
home care client having a distressed caregiver were three times higher
when the client had moderate to severe cognitive impairment, most often
related to Alzheimer's or other dementia.
The study found the odds of having a distressed caregiver were nearly
two to one for home care clients with symptoms of depression. Behaviours
such as resisting care, conflict with family and friends, and socially
inappropriate conduct were also significantly associated with caregiver
While a small number of seniors in home care displayed aggressive
behaviour, such as verbal or physical abuse, more than half (52%) of
these had caregivers indicating some form of distress, a rate almost
three times higher than the study average.
Quick facts on caregivers
Virtually all (98%) of the seniors in the study who were receiving
home care also had an informal caregiver, and nearly one in six (16%)
seniors had caregivers experiencing distress.
Among married clients, the primary caregiver was most often the spouse
(75%); adult children were the most common primary caregivers for
non-married clients (75%).
The odds of having a distressed caregiver were more than three times
greater among seniors with cognition problems, such as forgetfulness
or confusion, compared with those caring for seniors without these
The odds of having a distressed caregiver were two and a half times
greater for seniors receiving 21 or more hours of informal care
weekly, compared with those receiving 10 hours or less.
The odds of clients with symptoms of depression having a distressed
caregiver were nearly two to one, compared to those who were not
While the overall numbers of seniors displaying aggressive
behaviours—including physical and verbal abuse—was low, more than half
(52%) of these had caregivers indicating distress.
Quick facts on Alzheimer's and other dementia
One in five seniors (20%) living at home with home care had a
diagnosis of Alzheimer's disease and/or dementia.
- Of these,
one in six (17%) were managing at home with high levels of impairment
in basic mental
and physical functions.
Three in five seniors (57%) living in residential care (a nursing or
long-term care home) had a diagnosis of Alzheimer's disease and/or
- Of these, one in six (17%) had low levels of
impairment or could still perform basic functions quite
on their own.
The odds of a senior with low impairment being placed in residential
care rather than home care were seven times higher when the person was
wandering and nearly twice as high if he or she wasn't married.
The report and the following figures are available from CIHI's website,
Relationship of the Informal Caregiver to the Home Care Client, by
Marital Status (Figure 1 in Supporting Informal
Caregivers—The Heart of Home Care)
Caregiver Distress, by Client Mood and Behaviour (Figure 5 in Supporting
Caregiver Distress, by Client Cognition Level (Figure 6 in Supporting
ADL and Cognitive Impairment by Care Setting Among Seniors With
Dementia (Figure 7 in Caring for Seniors With Alzheimer's and
Other Forms of Dementia)
SOURCE Canadian Institute for Health Information
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